Pharmacists Increase Revenue with MTM--April 2009

Author: Eileen Koutnik-Fotopoulos, Staff Writer

Pharmacists are finding ways to increase cash flow by getting paid for in-depth consultations and other additional services. Kroger, for example, is training more pharmacists to handle up to 1-hour consultations with patients that it began offering members of sponsoring health plans 2 years ago.

These services are part of the medication therapy management (MTM) program, a requirement for all Medicare Advantage and prescription drug plan providers offering Medicare Part D benefits. Those sessions can produce fees of $160 for up to 1-hour conversations. In addition to covering medication therapy review and other components of MTM, some pharmacists perform extras for patients, including packaging patients' drugs in ready-to-use individual dosages to help control patients' misuse of medications.

"You've got to find creative niches to stay alive," said W. Shane Reeves, co-owner of Reeves-Sain Drug Store in Murfreesboro, Tennessee. "Pharmacists have traditionally gotten paid for dispensing medications; now this is a way to pay pharmacists more for being medication managers."

Sal Giorgianni, assistant professor with Belmont University's pharmacy school, said patient consultations are much needed in Tennessee, where the average resident fills 16 prescriptions at retail pharmacies per year, compared with the national average of 12, according to one report.

"It's well documented that when you reduce the number of medications that someone's taking, it also reduces the possibility of side effects and harmful interactions between medications," he said.

Now the Centers for Medicare&Medicaid Services is requiring private Medicare plans to do even more under revised guidelines. Beginning next year, more beneficiaries should qualify for MTM because plans must review their patient enrollments at least quarterly to identify eligible patients. Plans also will no longer be permitted to limit access only to members with a high number of chronic diseases or medications. Patients with at least $3000 of annual drug costs under Medicare's prescription drug benefit will be eligible. The current minimum is $4000 of annual drug costs.